白虎汤原方加人参三两 煮服同前法。
服桂枝汤,大汗出后,大烦渴不解,脉洪大者,
白虎加人参汤主之。烦渴不解,因汗多而胃液干枯,邪虽去而阳明之火独炽、故用此以生津止汗,息火解
烦。汗后诸变不同,总宜随症用药。
伤寒若吐、若下后,前汗后,此吐下后。七、八日不解,热结在里,表里俱热,此四字为白虎对症。
时时恶风,表邪未尽,大渴,舌上干燥,而烦,欲饮水数升者,胃液已尽,不在经、不在腑,亦非若承气
症之有实邪。因胃口津液枯竭;内火如焚,欲引水自救,故其象如此,与热邪在腑者迥别。白虎加人参
汤主之。
伤寒无大热,热在内。口燥渴,心烦,背微恶寒者,此亦虚燥之症。微恶寒,谓虽恶寒且甚微。又∶
周身不寒,寒独在背,知外邪已解,若大恶寒,则不得用此汤矣。白虎加人参汤主之。
伤寒脉浮,发热无汗,无汗二字,最为白虎所忌。其表不解者,恶寒。不可与白虎汤。渴欲饮水,无表
症者,不恶寒。白虎加人参汤主之。白虎加参汤,大段治汗、吐、下之后、邪已去而有留热在于阳明。又
因胃液干枯,故用之以生津解热,若更虚羸,则为竹叶石膏汤症矣。
壮火食气。此方泻火,即所以生气也。
竹叶(二把) 石膏(一斤) 半夏(半斤,洗) 人参(二两) 麦门冬(一升,去心) 甘草(二两,炙) 粳
米(半升) 上七味,以水一斗,煮取六升,去渣,纳粳米,煮米熟,汤成,又一煮法。去米,温服一升,日三服。
伤寒解后,虚羸少气,人参、麦冬。气逆欲吐者,半夏、竹叶。竹叶石膏汤主之。此仲景先生治伤寒愈
后调养之方也,其法专于滋养肺胃之阴气,以复津液。盖伤寒虽六经传遍,而汗、吐、下三者,皆肺胃当之。
又《内经》云∶人之伤于寒也,则为病热。故滋养肺胃,岐黄以至仲景不易之法也。后之庸医,则用温热
之药,峻补脾肾,而千圣相传之精义,消亡尽矣。
服用桂枝汤后,大汗出,出现严重烦躁、口渴且症状不缓解,脉象洪大的,用白虎加人参汤主治。烦躁口渴不缓解,是因为汗出过多导致胃中津液干枯,虽然表邪已去,但阳明经的火气独盛,所以用此方来生津止汗,平息火热解除烦躁。发汗后的各种变证不同,总应当根据具体症状用药。
伤寒病如果经过吐法或下法治疗后,或者经过发汗之后,到了七八天病情仍未解除,热邪结聚在体内,表现为体表和内部都发热,这“表里俱热”四个字是白虎汤的对症指征。
时常感到怕风,说明表邪尚未完全清除;极度口渴,舌面干燥,心中烦躁,想要喝几升水,这是胃中津液已经耗尽,病位不在经络也不在腑脏,也不是像承气汤证那样有实邪积滞。因为胃口处的津液枯竭,体内火热如焚烧,想要通过饮水来自救,所以表现出这种症状,这与热邪在腑的情况截然不同。用白虎加人参汤主治。
伤寒病身上没有大热,但热邪在内,口燥渴,心烦,背部微微怕冷的,这也是虚燥的症状。“微恶寒”是指虽然怕冷但程度很轻微。另外:全身并不寒冷,只有背部怕冷,可知外邪已经解除,如果是严重的怕冷,就不能使用这个汤剂了。用白虎加人参汤主治。
伤寒病脉象浮,发热但没有汗出,“无汗”这两个字是最忌讳使用白虎汤的。如果表证未解,伴有恶寒,不可给予白虎汤。如果口渴想喝水,且没有表证(不恶寒),用白虎加人参汤主治。白虎加人参汤,主要治疗经过汗、吐、下法治疗后,邪气已去而余热留存在阳明经的情况。又因为胃中津液干枯,所以用它来生津清热,如果患者更加虚弱消瘦,那就属于竹叶石膏汤的适应症了。
壮火会消耗元气。此方泻除壮火,也就是在补益元气。
竹叶(两把) 石膏(一斤) 半夏(半斤,洗净) 人参(二两) 麦门冬(一升,去心) 甘草(二两,炙烤) 粳米(半升) 以上七味药,用水一斗,煮取六升药液,去掉药渣,加入粳米,继续煮至米熟,药汤即成,这是另一种煎煮方法。去掉米粒,每次温服一升,每日服用三次。
伤寒病痊愈后,身体虚弱消瘦、气息短少,用人参、麦冬;气逆想要呕吐的,用半夏、竹叶。用竹叶石膏汤主治。这是张仲景先生治疗伤寒愈后调养的方子,其方法专门在于滋养肺胃的阴气,以恢复津液。大概伤寒虽然传遍六经,但汗、吐、下三种治法,都会损伤肺胃。又《内经》说:“人感受寒邪,就会发生热病。”所以滋养肺胃,是从岐伯、黄帝到张仲景以来不变的方法。后来的庸医,却使用温热性质的药物,峻补脾肾,使得千圣相传的精义完全消亡了。
The original Baizhu Tang (White Tiger Decoction) formula with the addition of Sanliang (3 liang) of Renshen (Ginseng Radix), decocted and taken according to the previous method.
After taking Guizhi Tang (Cinnamon Twig Decoction), if profuse sweating occurs followed by severe restlessness, unquenchable thirst that does not resolve, and a flooding pulse (Hongda Mai), Baizhu Jia Renshen Tang (White Tiger Decoction plus Ginseng) is indicated. The unresolved restlessness and thirst are due to excessive sweating causing dryness and depletion of stomach fluids; although the pathogenic factor has been expelled, the fire of Yangming alone blazes fiercely. Therefore, this formula is used to generate fluids, stop sweating, extinguish fire, and relieve restlessness. The various changes after sweating differ, so one should always prescribe medication according to the specific symptoms.
If Taiyang Cold Damage (Shanghan) undergoes emesis or purgation therapy, or follows sweating, and remains unresolved after seven or eight days, with heat binding internally and both exterior and interior manifesting heat—these four characters "exterior and interior both hot" are the indications for Baizhu Tang. Occasional aversion to wind indicates that exterior pathogens have not yet fully cleared; extreme thirst, dry tongue surface, mental restlessness, and desire to drink several liters of water indicate that stomach fluids are exhausted. The pathology is neither in the meridians nor in the fu organs, nor is it like Chengqi Tang syndrome which involves excess pathogens. Due to the depletion of fluids at the stomach opening and internal fire burning like flames, the body seeks self-rescue by drawing in water, thus presenting such symptoms. This is distinctly different from heat pathogens residing in the fu organs. Baizhu Jia Renshen Tang (White Tiger Decoction plus Ginseng) is indicated.
In Taiyang Cold Damage, if there is no significant external heat but heat resides internally, accompanied by dry mouth and thirst, mental restlessness, and slight aversion to cold on the back, this is also a deficiency-dryness syndrome. "Slight aversion to cold" means that while there is aversion to cold, it is very mild. Furthermore: if the whole body is not cold, but only the back feels cold, it is known that exterior pathogens have resolved. If there were severe aversion to cold, this decoction would be contraindicated. Baizhu Jia Renshen Tang (White Tiger Decoction plus Ginseng) is indicated.
In Taiyang Cold Damage, if the pulse is floating, there is fever but no sweating—the phrase "no sweating" is strictly contraindicated for Baizhu Tang. If the exterior pattern is unresolved, manifested by aversion to cold, Baizhu Tang must not be given. If there is thirst desiring water and no exterior pattern (no aversion to cold), Baizhu Jia Renshen Tang (White Tiger Decoction plus Ginseng) is indicated. Baizhu Jia Renshen Tang primarily treats conditions where, after sweating, emesis, or purgation, the pathogen has gone but lingering heat remains in Yangming. Because stomach fluids are depleted, it is used to generate fluids and clear heat. If the patient becomes more weak and emaciated, it becomes a Zhuyegao Shitang (Bamboo Leaf and Gypsum Decoction) syndrome.
Vigorous fire consumes qi. By clearing fire, this formula thereby generates qi.
Zhuye (Bamboo Leaves, 2 bunches), Shigao (Gypsum Fibrosum, 1 jin), Banxia (Pinelliae Rhizoma, 0.5 jin, washed), Renshen (Ginseng Radix, 2 liang), Maimendong (Ophiopogonis Radix, 1 sheng, heart removed), Gancao (Licorice Root, 2 liang, honey-fried), Jingmi (Glutinous Rice, 0.5 sheng). These seven ingredients are decocted in 1 dou of water until 6 sheng remain. Strain the dregs, add the glutinous rice, and continue cooking until the rice is ripe and the decoction is ready. This is an alternative decoction method. Remove the rice, take 1 sheng warm, three times daily.
After Taiyang Cold Damage resolves, if the patient presents with weakness and emaciation, shortness of breath (indicated by Renshen and Maimendong), and rebellious qi with nausea/vomiting (indicated by Banxia and Zhuye), Zhuyegao Shitang (Bamboo Leaf and Gypsum Decoction) is indicated. This is Master Zhang Zhongjing's formula for post-Taiyang Cold Damage convalescence. Its method focuses specifically on nourishing the yin qi of the Lung and Stomach to restore body fluids. Although Taiyang Cold Damage may transmit through all six meridians, the therapies of sweating, emesis, and purgation all affect the Lung and Stomach. As stated in Neijing (Inner Canon): "When humans are injured by cold, they develop febrile diseases." Therefore, nourishing the Lung and Stomach is the unchanging method from Qibo and Huangdi to Zhang Zhongjing. Later mediocre physicians, however, use warming and hot medicines to vigorously tonify the Spleen and Kidney, causing the profound essence passed down through thousands of sages to vanish completely.